What if the anal fissure does not heal with the above measures?
An anal tear (fissure) will usually heal within 1-2 weeks in most people. However, it can take longer to heal in others.
Glyceryl trinitrate ointment
If you apply glyceryl trinitrate (GTN) ointment to the anus, it relaxes the muscle around the anus (the anal sphincter). It also increases the blood supply to the damaged skin by dilating the blood vessels in that area. This may allow the fissure to heal better. It may also ease the pain.
GTN ointment may help in some, but not all, cases. Research studies showed that, for people with a chronic anal fissure, about 6 in 10 fissures healed with GTN treatment. This compared to about 5 in 10 that healed with no treatment. So, the effect of GTN ointment is modest but may well be worth a try.
Some studies have shown that other medicines may also help to relax the anal sphincter muscle and increase the blood supply to the area, so helping healing of an anal fissure. For example, medicines called calcium-channel blockers, such as diltiazem. These medicines may sometimes be suggested for people unable to use GTN ointment.
An injection of botulinum toxin into the anal sphincter muscle has also been shown to relax the anal sphincter muscle and so help anal fissures to heal. This treatment may be suggested if other treatments have not been successful.
An operation is an option if the fissure fails to heal or comes back. The usual operation is to make a small cut in the muscle around the anus (internal sphincterotomy). This permanently reduces the tone (pressure) around the anus and allows the fissure to heal. This is a minor operation which is usually done as day case surgery (you will not usually have to stay overnight in the hospital). The success rate with surgery is very high. At least 9 in 10 cases are cured.
Laser Ablation of the Fissure with Laser Anal Sphincterotomy is the latest advance in the surgery and it gives superior results in terms of minimum postoperative bleeding, negligible pain,faster recovery…and no cutting during the entire surgery.